Some risk factors for refractory chronic sinusitis: an immunohistochemical and electron microscopic study

The goal of the present work was to investigate possible risk factors for the poor response of some cases of chronic sinusitis to endoscopic sinus surgery in spite of the precision of the surgical technique. Eleven adult patients who were scheduled for revision endoscopic sinus surgery underwent a complete allergy workup. At the time of surgery, a tiny biopsy was taken from the maxillary sinus mucosa close to the middle turbinate. The specimens were processed for histochemical and transmission electron microscopic examination. Six patients (55 per cent) proved to be allergic. Their sinus mucosa showed eosinophilic infiltration (6.1 cells/mm(2)), and mast cell degranulation. This proves that allergens can reach the sinus mucosa and have a direct impact on it. Another three patients (27 per cent) were non-allergic but exhibited mucosal eosinophilia (5.0 cells/mm(2)), and two of them showed mast cell degranulation. These patients were diagnosed as having nonallergic rhinosinusitis with eosinophilia (NARSE). The nasal mucosa of the remaining two patients did not reveal any characteristic pathological findings, and no pathologic diagnosis could be established for them. None of the patients showed electron microscopic evidence of purulent inflammatory changes, and the bacterial cultures recovered normal respiratory flora in nine patients (82 per cent). The present research spotlights the importance of allergy and nonallergic eosinophilic infiltration of the mucosa as possible risk factors that may degrade the results of endoscopic sinus procedures and discusses some pertinent pathological and clinical aspects.     

慢性鼻窦炎手术前后血清和鼻腔分泌物中表皮生长因子水平变化

目的了解慢性鼻窦炎手术前后血清和鼻腔分泌物中表皮生长因子(epidermalgrowth factor,EGF)水平的变化,探讨EGF在鼻内镜术后术腔上皮过程中可能的作用。方法采用放射免疫方法检测慢性鼻窦炎手术患者术前及术后1、2、3、4、6、8周血清和鼻腔分泌物中EGF含量,并分析其变化规律。结果与正常对照比较,慢性鼻窦炎患者血清及鼻腔分泌物中EGF含量均升高,后者更为明显(P<0.0 5);术后第1周鼻腔分泌物中的EGF水平明显降低(P<0.05),第4周后开始升高;血清中EGF水平手术后呈缓慢下降,第6周后者开始上升。结论慢性鼻窦炎手术后血清和鼻腔分泌物中EGF水平存在一定归律的变化,这种变化模式与术后黏膜的转归以及创面修复有关,表明EGF术后鼻腔黏膜修复与上皮化过程中具有重要作用。     

Pulmonary aspiration of nasal secretions in patients with chronic sinusitis and asthma

BACKGROUND: The role of silent aspiration of nasal secretions in the pathogenesis of asthma has often been questioned. OBJECTIVE: To investigate the presence of pulmonary aspiration of nasal secretions during sleep in patients with chronic sinusitis and asthma and in healthy controls. DESIGN: Prospective, controlled trial. SUBJECTS: The study included 13 patients with chronic sinusitis and asthma and 12 healthy controls. The diagnoses were based on history, physical examination findings, radiologic assessments, and pulmonary function test results. INTERVENTIONS: A radioactive tracer was prepared by diluting 10 mCi of technetium 99m-labeled macroaggregated albumin in 10 mL of physiologic saline. At 10 PM, just before the patients went to sleep, the solution was sprayed into their nostrils. The subjects were examined with a gamma camera to obtain views of the thorax at 8 AM the following morning. The average counts of the lungs and background and the actual lung counts (average lung count minus average background count) were determined. RESULTS: The average counts of the lungs were significantly greater than the average counts of the background in both the sinusitis-asthma group (P =.001) and the control group (P =.002). The difference in the actual counts of the lungs was not significant between the 2 groups (P =.79). CONCLUSIONS: The nasal secretions were aspirated into the lungs both in patients with sinusitis and asthma and in healthy adults during sleep, and the relative amounts that were aspirated did not differ significantly between the 2 groups (P =.79). The amount of the aspirated material alone is probably not responsible for the pathogenesis of asthma in patients with chronic sinusitis.     

鼻中隔偏曲及慢性鼻窦炎鼻息肉患者的精神心理状态调查

目的 初步调查鼻中隔偏曲(DNS)、慢性鼻窦炎鼻息肉(CRSwNP)患者的精神心理状况,观察其手术前后的心理变化。 方法 利用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估44例CRSwNP、41例DNS、31例声带息肉患者(对照组)手术前后焦虑、抑郁症状。另取39例健康者作健康对照。 结果 术前各组的SAS和SDS评分依次为:健康组(36.74±10.39; 38.51±11.30)、对照组(38.52±10.99; 42.26±10.42)、CRSwNP组(42.00±13.54; 43.84±15.44)、DNS组(45.02±10.80; 48.32±11.21)。健康组、对照组与DNS组之间的SAS和SDS评分差异有统计学意义(P<0.01)。CRSwNP组和DNS组的术前、术后的SAS和SDS评分差异有统计学意义(P<0.05)。约1/3的DNS组和CRSwNP组的患者术后仍出现焦虑或抑郁症状。 结论 DNS、CRSwNP患者存在一定的焦虑、抑郁症状,术后其评分较术前改善,但约1/3的患者术后仍有焦虑、抑郁症状,必要时应给予心理干预。     

奥玛株单抗在慢性鼻窦炎伴鼻息肉患者治疗中的应用

慢性鼻窦炎伴鼻息肉(CRSwNP)的炎症机制复杂,现有治疗方式对其病情控制欠佳。奥玛株单抗可通过与IgE受体结合降低患者的免疫级联反应,已有研究证明其对缓解CRSwNP合并哮喘患者的鼻部症状有良好的效果,但针对伴嗜酸性粒细胞增多、IgE水平高的难治性复发性CRSwNP治疗效果的探索还需要更多、更大规模的随机对照实验来证明。本文结合该背景对奥玛株单抗的作用机制以及在CRSwNP中的应用进行阐述,为CRSwNP的治疗提供参考。     

The epithelium and chronic inflammatory cells in scleroma. (An electron microscopic study)

The ultrastructure of 15 cases or rhinoscleroma have been studied. The epithelium showed intercellular edema, a reaction to the polysaccharide coat of intact bacilli, passing through defects in the basal lamina and subsequently inviting polymorph migration. The transitional stages between normal and 'reactive' plasma cells to the formation of the Russell body and the Unna cell were demonstrated, thus supporting the theory of an intracellular formation of the Russell bodies.     

Ostial and nasal patency in chronic maxillary sinusitis. A long-term post-treatment study

In a long-term follow-up study (mean 3.5 years) after treatment of chronic maxillary sinusitis of either rhinogenous or dental origin, 72 sinuses in 66 patients were examined with respect to maxillo-ostial and nasal resistance. In sinusitis of rhinogenous etiology, the mean equivalent ostial diameter was pathologically narrowed (0.89 mm, in patients treated conservatively) whereas it was normal (2.51 mm) in sinusitis of dental etiology (dental treatment in combination with local sinus surgery). In the former group, all sinuses were diseased, compared with 3 out of 23 in the dental group. In order to distinguish between functional and organic ostial stenosis, the patients were also tested after physical exercise. The functional ostial diameter in healthy sinuses was significantly increased in contrast to the diseased sinuses. In one patient the narrow ostium was due to mucosal swelling only, but in the other cases was caused mainly by an organic stenosis. In sinusitis of rhinogenous etiology, a pathologically increased nasal resistance was found in 14.3%, while the corresponding figure in the dental group was 4.3%. Improved sinusal and nasal ventilation, achieved either pharmacologically or, preferably by surgical intervention, seems necessary for successful treatment of chronic maxillary sinusitis.     

Abnormal "hair-like" filaments in chronic maxillary sinusitis . A scanning electron microscopic investigation

Scanning electron microscopic investigations were performed on the maxillary sinus mucosa of five healthy persons and seven patients with chronic maxillary sinusitis. The occurrence of previously undescribed hair-like filaments in one case of chronic maxillary sinusitis is presented. These abnormal filaments are much longer (about 50--60 micron) and thinner (about 0.08 micron) than normal kinocilia (about 0.2 micron thick and 5--7 micron long), thus exhibiting a hair-like appearance. As the microvilli (cytofila) in maxillary sinus mucosa have the same thickness (about 0.08 micron), these hair-like filaments could be regarded as abnormally long microvilli. The possible significance of these abnormal filaments is discussed.     

Amoxicillin concentrations in nasal secretions of patients with acute uncomplicated sinusitis and in paranasal sinus mucosa of patients with chronic sinusitis

In this prospective randomized clinical study a total of 59 patients of both sexes (above 18 years of age) were enrolled. Thirty patients with acute sinusitis were randomly allocated to two treatment groups, one group receiving 1000 mg amoxicillin every 12h for 10 days and the other group receiving 500 mg amoxicillin every 8 h for 10 days. The median concentration of amoxicillin in nasal secretions was 2.34 µg/ml in the 12-h administration group and 1.95 µg/ml in the 8-h administration group. Median bioavailability of antibiotic at 8-24h did not show any statistical differences between the two treatment schemes [probability (Z) = 0.2]. Twenty-nine patients with chronic sinusitis were then randomly allocated to three groups, with patients receiving 1000 mg amoxicillin at 12, 8 or 6 h before nasal and/or sinus surgery was carried out. The mean amoxicillin concentrations in mucosal tissues removed intraoperatively ranged from 0.69 to 0.99 µ/g sample. Statistical evaluation by analysis of variance did not show any statistically significant differences among the three treatment groups [probability (F) = 0.1705]. In all cases of acute and chronic sinusitis, amoxicillin concentrations exceeded minimum inhibitory concentration values for pathogens common in sinusitis. Our results indicate that 1000 mg amoxicillin administered twice daily produces tissue concentrations high enough to be clinically effective in patients with either acute or chronic sinusitis.     

鼻内窥镜下鼻窦鼻息肉手术75例疗效观察

目的：观察鼻内窥镜下鼻窦鼻息肉手术治疗的效果。方法：对75例（125侧）慢性鼻窦炎鼻息肉患者行鼻内窥镜下手术,术后随访1年。结果：治愈48例（64.0%）,好转20例（26.7%）,无效7例（9.3%）,总有效率90.7%。术后并发症主要为鼻腔黏连。结论：鼻内窥镜下鼻窦鼻息肉手术治疗具有良好的疗效,术中正确处理中、下鼻甲及鼻中隔,术后定期随访可提高治愈率,减少并发症。     

Quantification of interleukin-1 in nasal polyps from patients with chronic sinusitis

Summary We have measured interleukin-1 (IL-1) and levels in nasal polyps (NP) from patients with chronic sinusitis (CS) in order to determine their significance in the pathogenesis of NP. NP in ten cases (five male and five female; age range, 17–63 years) were removed to separate mononuclear (M) and polymorphonuclear (PMN) fractions through Ficoll-Paque separation media. ELISA measurements of the M fraction showed that the mean value of IL-1 was 17.8 pg/mI per gram, which was significantly higher than that of IL-1 (7.04 pg/ml per gram, P<0.01, Wilcoxon test). In the PMN fraction, the mean value of IL-1 was 8.79 pg/ml per gram and that of IL- was 7.85 pg/ml per gram, which was not significantly different. Mononuclear leukocytes, particularly activated monocytes, seem to be a major source of IL-1 in the NP taken from patients with CS.     

HRCT与鼻内镜对鼻窦炎鼻息肉相关异常诊断的比较

目的对照鼻窦炎鼻息肉的冠状位HRCT表现与FESS术中内镜所见,比较两种方法对鼻腔内间隙、窦口等异常的精确诊断能力。方法详细记录102例(202侧)鼻窦炎鼻息肉冠状位HRCT表现与FESS手术中所见。结果①对鼻腔内间隙和上颌窦口狭窄的检出,CT优于内镜;对前筛口、后筛口和蝶窦口的显示,内镜优于CT。②中鼻道息肉和鼻中隔偏曲的诊断率,内镜高于CT。③上颌窦内异常,如黏稠脓液、黏膜增厚、息肉、黏膜囊肿等,CT表现有一定特点。结论冠状位HRCT和内镜对鼻窦炎鼻息肉相关异常的精确诊断各有优势,应该互相补充、印证,不可以相互替代。     

慢性鼻窦炎鼻息肉鼻内镜术后的康复治疗

目的:分析鼻息肉、慢性鼻窦炎经鼻内镜手术后影响疗效的因素,并探讨其预防措施。 方法:对因鼻息肉、慢性鼻窦炎接受鼻内镜手术、随访3年以上的226例患者从职业、个人生活习 惯、术后是否坚持系统的康复治疗及持续时间、临床转归等方面进行回顾性分析。结果:从事接触 刺激性物质或粉尘的职业(化工、纺织、建筑、装饰、锅炉和厨师等)、具有不良生活习惯(喜食辛辣 食物、嗜烟酒)、术后(尤其是出院后)根本不曾或不能坚持进行系统康复治疗(包括局部用药、全 身用药、鼻腔冲洗、定期鼻内镜下清理术腔等)的患者与不具有前述"特质"的患者鼻息肉、鼻窦炎 复发的可能性明显居高、复发时间亦明显提前;具备前述"特质"类别愈多,复发愈快、愈剧。其中 尤以系统康复治疗对术后转归影响最显著。结论:术后定期、足够疗程的系统康复治疗是提高鼻 息肉、慢性鼻窦炎经鼻内镜手术疗效的有力措施,良好的职业保护和戒除不良生活习惯能有效地 预防和减缓鼻息肉、慢性鼻窦炎经鼻内镜手术后的复发。     

1035例慢性鼻窦炎鼻息肉患者嗅觉功能测试结果的分析

目的 :寻找嗅觉定量分析指标 ,以准确的评价嗅觉功能。方法 :采用 T& T标准试嗅法对 10 35例慢性鼻窦炎鼻息肉患者嗅觉功能进行测试 ,将结果与其嗅觉主诉相比较并分析。结果 :186 .3%的患者有嗅觉功能障碍 ;2患者嗅觉主诉与嗅觉测试结果之间存在着极显著性差异 ,配对 t检验 P =0 .0 0 0。结论 :以患者的主诉作为嗅觉功能的评价依据缺乏可靠性和科学性 ,应以患者的嗅觉识别阈来评价嗅觉功能     

Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.     

A study of infiltrated cells in the maxillary mucosa in nasal allergy and chronic sinusitis

The cloudiness of the maxillary sinus in Waters-view is 37% in patients with nasal allergy. The pathogenesis of this cloudiness has not fully understood yet; is it due to the type- I allergic reaction, or secondary maxillary sinusitis? To clarify the pathology, we studied the infiltrated cells in 37 mucosae of the maxillary sinus in which X-ray revealed an abnormal shadow. Samples were also taken from 9 antrums with chronic sinusitis, and 18 and 4 nasal mucosae form the inferior turbinate with nasal allergy and sinusitis, respectively. Each specimen were fixed with Carnoy solution and formalin, and were stained with Hematoxylin & Eosin, and with Alcian blue & Safranin. Numbers of formalin sensitive and resistant mast cells and eosinophils were determined in the epithelium, and superficial and deep layers of the lamina propria, respectively. The population of both mast cells in each compartment was not different between nasal allergy and maxillary sinusitis both in the nasal and maxillary mucosae. The number of eosinophils in the maxillary and nasal epithelial significantly increased in nasal allergy compared with sinusitis. These results suggested that type-I allergic reaction might occur in the maxillary mucosa as well as nasal mucosa in patients with nasal allergy.